PROSTATE CANCER AWARENESS MONTH

In the U.S., 1 in 6 men will be diagnosed with prostate cancer in their lifetime, making it the most frequently diagnosed cancer in men after skin cancer.

Despite these figures, the level of awareness, understanding and support for prostate cancer lags significantly behind that of women’s health causes.

• A man is 35% more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
• One new case of prostate cancer occurs every 2.2 minutes and a man dies from the disease every 17.5 minutes.
• The incidence rates are double for African American men.
• If detected and treated early, prostate cancer has a 97% percent success rate.

What is the prostate?
The prostate is a gland forming part of the male reproductive system.  In younger men the prostate is about the size of a walnut.  It is located immediately below the bladder and just in front of the bowel.  Its main function is to produce fluid that protects and enriches sperm.  It is doughnut shaped as it surrounds the beginning of the urethra, the tube that carries urine and semen out through the penis.  The nerves that control erections surround the prostate.

What is prostate cancer?
Prostate cancer occurs when some of the cells of the prostate reproduce much more rapidly than in a normal prostate, causing a tumor.  If left untreated, prostate cancer cells may eventually break out of the prostate and invade distant parts of the body, particularly the bones and lymph nodes, producing secondary tumors, a process known as metastasis.  Once the cancer escapes from the prostate, treatment is still possible but is more intensive and difficult.

If appropriate treatment begins while the cancer is still confined to the prostate gland, it is possible to prevent the progression of the disease.

One of the most worrying aspects of the disease is that most prostate cancers develop without men experiencing any symptoms.

What are the risk factors?

• Gender: Prostate cancer only affects men as women do not have a prostate gland.
• Age: The older a man, the more likely he is to be diagnosed with prostate cancer, about 97% of all prostate cancers are diagnosed in men 50 and older.
• Family History: A man with a father or brother who developed prostate cancer before age 60 is twice as likely to develop the disease.
• Ethnicity: African American men are more likely to develop prostate cancer and are nearly 2.5 times as likely to die from the disease.
• Lifestyle: Poor diet and lack of exercise.

What are possible symptoms?
While the majority of prostate cancers have no symptoms, advanced disease that has spread throughout the prostate (and beyond) can cause urinary symptoms such as:

• Slow Flow: Urine flow is slow and difficult to stop
• Hesitancy: Difficulty starting flow of urine
• Frequency: Need to urinate more frequently
• Nocturia: Need to urinate during the night
• Urgency: Urgent need to urinate
• Blood in the urine or semen
• Reduced ability to get an erection
• Painful ejaculation

It’s important to note that these symptoms are common to many different conditions, not just prostate cancer.

TESTING
Men should talk to their doctor about prostate cancer testing. There are advantages and disadvantages to PSA testing.  Understand the prostate cancer risk factors, discuss these with your doctor and decide if prostate cancer testing is right for you.

What tests are available?
The purpose of testing is to detect prostate cancer at its earliest stages, before any symptoms have developed. 
There are two tests: Physical Examination (DRE: Digital Rectal Exam); Blood Test (PSA: Prostate Specific Antigen)

The PSA blood test (PSA)

The PSA blood test looks for the presence in the blood of a protein that is produced specifically by prostate cells called Prostate Specific Antigen (PSA). The presence of an elevated PSA does not necessarily mean prostate cancer is present as there are other medical conditions that can lead to a PSA result outside the normal range.  These include enlargement of the prostate (Benign Prostatic Hyperplasia or BPH) and inflammation of the prostate (prostatitis).

The Digital Rectal Exam (DRE)

The DRE involves the doctor inserting a gloved finger in the anus, where it is possible to feel part of the surface of the prostate. Irregularities include swelling or hardening of the prostate, or lumps on the surface that may indicate development of a tumor or other problems. The drawback to this test is that the doctor can feel only part of the prostate, so some irregularities may be beyond reach.

If the results of a test are abnormal your doctor would refer you to a specialist (i.e. Urologist) to take a tissue sample in the form of a biopsy.  A biopsy is the only way to determine if cancer is present.  A doctor typically diagnoses prostate cancer after closely examining biopsy cells through a microscope. There are several types of cells in the prostate and each contributes in its own way to the prostate’s development, architecture and function. Cancer cells look different than normal prostate cells. Pathologists look for these differences first to detect the presence of cancer and then to determine the cancer grade. Doctors will perform various tests to stage the cancer, determine its risk and develop a treatment plan.

To test or not to test?
The question of testing is a personal and complex one.  It’s important for every man to talk with his doctor about whether prostate cancer testing is right for him.

There is no unanimous opinion in the medical community regarding the benefits of prostate cancer testing.  Those who advocate regular testing believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects.

Ultimately, decisions about testing should be individualized based on a man’s level of risk, overall health, and life expectancy, as well as his desire for eventual treatment if he is diagnosed with prostate cancer.